Yesterday I received an email from Medtronic. It was an early release version of the Sunshine Act data that they had sent to the government. The Sunshine Act, passed in 2010 but implemented in 2013, demands the collection and publication of data on payments to physicians in the form of food, travel, or other goods. This data will be made available online to the public in September of this year. Medtronic, a major manufacturer of pacemakers and implantable defibrillators, was nice enough to release to me the data on the money that they had spent on me. Below is a copy of the report.
Perhaps a foreshadowing of what could go wrong with such a database, there is a $90.38 charge to Nancy’s Haute Affairs (I looked it up. It is a restaurant, not an escort service) in Pensacola, Florida. But I’ve never been to Pensacola in my life. So this charge is wrong. The rest of it appears to be lunch and breakfast stuff the Medtronic reps thoughtfully provided to our office, or to the break room at the various cath labs I worked at. In looking at these charges, it is important to remember that I did not ask Medtronic to go out and order some Panera. Medtronic brought it in, and once it’s there it is difficult to resist snatching a bagel, even though each bagel snatched results in another database entry under the Sunshine Act. Given the natural tendency of hungry doctors (I almost never ate lunch at work) to partake of “free” food lying around, I think the more interesting question is not how much did each doctor consume, but rather, how much did a company such as Medtronic spend on doctors in an attempt to curry favor. I’m not sure if the Sunshine Act involves publication of that data, but it should.
There is no doubt that drug and device companies do try to target doctors in order to increase sales of their products, and money going from these companies to doctors is the major means of influence. Doctors sign up to be on speaking panels for drug or device companies, even though they are not particularly expert on the specific drugs or devices they are talking about. They receive a professional set of slides from the company and a nice stipend. Other docs, particularly those in academic medicine, serve on advisory boards for companies, again resulting in a nice stipend as well as travel and lodging to exotic parts of the world. Although there is a difference between the appearance of a conflict of interest and an actual conflict of interest, perhaps this distinction will appear a bit too fine when the actual dollar amounts these doctors receive are published. The question becomes: how much money received is too much? Any amount at all? More than $1000? More than $10,000? Arguments on what’s reasonable aside, there’s no doubt that some doctors are susceptible to this kind of influence, and others will just take the bagel and ignore where it came from.
When I was practicing as an electrophysiologist I felt I was in the latter category. The last thing I thought about when deciding what kind of device to put in was where my last bagel came from. My colleagues in electrophysiology I feel were similarly immune to this kind of influence. I can’t say the same about all my referring physicians. Most didn’t care what brand device I put in, but there were some exceptions. Some would call me with a referral of a patient who needed a pacemaker or implantable defibrillator and at the end of the presentation would close by saying: “and please put in a [insert specific brand name here] device.” Yes the device companies wine and dine the referring physicians who don’t actually put in the device, in order for them to pressure the implanting physician to use their specific devices. Admittedly some of these non-implanting referring physicians do device follow-up in their office, which usually involves a rep from the company actually coming to the office and doing the device interrogations (see my earlier post on this topic). These referring doctors will say they have a preference to follow a certain brand of device, which usually means they get along well with the particular rep from that company who comes to their office and does their work for them. I always found this practice particularly annoying. I as the implanting physician should decide what device to put in, based on my judgment on what’s the best device for the patient. I’m sure the referring physician would not like it if I told him or her what brand stent to put in my patient.
So it would be naive to deny that there is any influence peddling going on between drug and device companies and physicians. Sure it probably pales in comparison to what goes on between lobbyists and politicians in Washington, but don’t hold your breath for Congress to shine the sunlight on their own activities. And based on the preliminary report I received, I’m sure there are going to be a lot of unhappy physicians when the final reports are released to the public in September.